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Insurance & WLS

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Old 01-26-2010, 12:28 AM   #1
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Default Insurance & WLS

I was wondering if anyone out there can share any information/experience they have about insurance covering weight loss surgery.

My current insurance does cover certain weight lost surgeries, but, I've heard some real horror stories about getting them to agree to it.

I've played around with the idea in my head. I'm 25, 5'2", and 230 pounds according to my home scale. My BMI is 40+. I've been heavy since childhood. 120 was my lowest weight, from ages 11-15. Since 15, I've been steadily gaining weight over the years. I've tried everything, it seems like. I haven't been able to get below 190 in years. I went to the gym for months, and ultimately failed at doing that, too.

I'm still working on losing weight now, and sometimes I feel very selfish for even thinking about weight loss surgery.

I've never had any issues directly related to my body weight... Don't ask me how. I think that this is one of the things that they take into account when considering you.

Like I said, I feel very selfish for considering weight loss surgery. I may be very obese, but, I am still able bodied. It's less physical, and more mental.

So, please share with me your stories, wisdom, and advice on this matter.

Did you go through your insurance? Are you thinking about going through your insurance?
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Old 01-26-2010, 07:04 AM   #2
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It all depends on the insurance policy. I had Aetna, and, as long as I jumped through their hoops (psych eval, monitored diet, etc.), I had no trouble getting approved. If your BMI is 40+, then you likely don't need any additional health issues in order to qualify. Check your policy to find out what their exact requirements are. You may have to call them or check for a manual on their website, as this information is not typically included in the info you get from HR.
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Old 01-26-2010, 08:27 AM   #3
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Quote:
Originally Posted by jillybean720 View Post
It all depends on the insurance policy. I had Aetna, and, as long as I jumped through their hoops (psych eval, monitored diet, etc.), I had no trouble getting approved. If your BMI is 40+, then you likely don't need any additional health issues in order to qualify. Check your policy to find out what their exact requirements are. You may have to call them or check for a manual on their website, as this information is not typically included in the info you get from HR.
Thanks for the info.

I did look it up on their website. I'm on Health Plan of Michigan. This is all their website says...

Quote:
Originally Posted by Health Plan of Michigan
Bariatric surgery may be a covered benefit if you meet specific criteria. This benefit is limited to one bariatric procedure per lifetime and is limited to Roux-en-Y Gastric Bypass (laparoscopic or open). Members who have had a bariatric surgery prior to joining HPM are not eligible for a second surgery through HPM. Bariatric evaluations and surgery must be performed at one of HPM's bariatric surgery Centers of Excellence. The bariatric surgery Centers of Excellence are:

* Detroit Medical Center/Harper Hospital Detroit, MI
* Henry Ford Hospital Detroit, MI
My first step would probably be to talk to my own doctor about it, as I'm pretty sure she probably knows what I would have to do.

I would only consider this as a last resort. I am currently trying to lose weight on my own, and I am trying very hard to stick with it. There are things about weight loss surgery that scare me; The surgery itself, the recovery time, and like many others here, the rapid weight loss causing loose skin. I do not have the money to surgically fix any loose skin that may decide to "hang around" and that scares me, too.

Thanks for responding, I really appreciate it.
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Old 01-26-2010, 08:38 AM   #4
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Hi there Techno! the info you posted from the health plan sounds pretty standard. the RULES for WLS are that your BMI be over 40, or that it be at least 38 with comorbid conditions [like diabetes, high blood pressure, sleep apnea].

you're right - a good next step would be a chat with your doc.

as for the loose skin, ask yourself this Q: can you live with yourself at a healthy weight even if you don't look so good naked? some people can - others can't.

keep us posted! make sure you get all the facts, and make the right choice for YOU.
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